Provider Demographics
NPI:1073521688
Name:ROBINSON, DEREK THOMAS ALDAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEREK THOMAS
Middle Name:ALDAY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E PINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5536
Mailing Address - Country:US
Mailing Address - Phone:209-463-5800
Mailing Address - Fax:209-463-5900
Practice Address - Street 1:534 E PINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5536
Practice Address - Country:US
Practice Address - Phone:209-463-5800
Practice Address - Fax:209-463-5900
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5723225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ41705Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST